Affordable Care Act and The Health Insurance Marketplace

Health Insurance Provides Peace of Mind

Health insurance can be affordable. For some, government subsidies offset the cost of insurance. Others may be eligible for Medicaid when previously they were not. Avoiding penalties for not having insurance should be a factor too. Most importantly, health insurance provides peace of mind.

The Health Care Law

According to the Affordable Care Act, everyone who legally lives in the United States must have health insurance.
For millions of uninsured people, this law gives access to healthcare plans at different cost levels. Based on their income and family size, those who qualify also may receive financial assistance when purchasing these plans.

You may compare plans at the Health Insurance Marketplace, also known as an exchange. This one-stop shop allows you to choose a plan that fits your budget and coverage needs.

We’re here to help you learn about the law and how to select the right plan for you and your family.

What Will the Plans Cover?

All plans include coverage for doctor visits, hospital stays, wellness care, prescriptions, emergency services and more. In fact, there are 10 essential health benefits that are included in every plan, and certain preventive care services will be provided at no additional cost to patients. Insurers cannot deny coverage because of pre-existing conditions.

Open Enrollment Begins November 1

If you do not have health insurance, you must sign up for 2017 coverage during open enrollment, from November 1, 2016 to January 31, 2017. You can shop for plans by phone, through a broker or at the online Marketplace, where you can compare benefits and costs easily. Those who do not sign up will face tax penalties.

If you currently have “charity care,” you should sign up for health coverage. With health insurance, you will be covered for things like doctors’ visits and prescription medicines, which are not covered now – and may not be covered when your charity care coverage ends.

If you are interested in receiving one-on-one assistance to compare insurance options, 609-456-0820 to speak with an enrollment representative. Or visit Healthcare.gov for additional information.

The Marketplace

The Health Insurance Marketplace is available online, by phone or through an approved insurance broker. It’s designed to help you buy health coverage more easily.

You can compare plans side by side, in simple language, and there’s no fine print. You can choose between four levels of health plans—Platinum, Gold, Silver and Bronze—from a variety of approved insurance providers. Each offers different amounts of coverage and different monthly premiums. Only one simple application is required.

Open Enrollment Begins November 1!

Call 609-456-0820 to speak to an enrollment representative about local coverage options, or visit www.HealthCare.gov to apply for coverage, compare plans and enroll in coverage.

Renewing Your Marketplace Health Insurance Plan.

The Open Enrollment Period is when individuals can purchase health insurance plans. If you already have health insurance, it is the time for you to shop for new Marketplace coverage or decide to stay in the same, or a similar, plan. This year, the Marketplace Open Enrollment Period is from November 1, 2016 through January 31, 2017.

Your health insurance company will send you a letter by November 1, 2016 to let you know if your plan is still being offered and how the plan is changing.

If your health insurance company will offer a plan in your area for 2017: The letter you get from your health insurance company will tell you the new monthly premium amount and any changes to the plan. If you have questions about plan benefits, which providers are in-network, or how to pay your premiums, call your health insurance company directly.

If your health insurance company won't offer a plan in your area for 2017: Your health insurance company may decide to stop offering certain plans next year. If your health insurance company won't offer a plan in your area for 2016, then you'll need to choose a new plan for 2016 to continue having coverage.

Be sure to go to HealthCare.gov to make sure your current plan is still right for you. Be sure that the plan works for you – for example, that the doctors and hospitals you use, and prescription drugs you need, are still in-network. In most cases, if you do not take action, your health insurance company will automatically enroll you in the plan you currently have or the one most similar to it if your plan is no longer available.

From November 1, 2016 to January 31, 2017, you can:

Update your application information.

See if you qualify for new or different help paying for your premiums and out-of-pocket costs.

Compare available plans.

Enroll in a plan that meets your needs.

Remember, you must enroll in a plan by December 15, 2016 for coverage in your new plan to start on January 1, 2017.
To learn more about making updates, visit www.HealthCare.gov/keep-or-change-plan/. You can also call the Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325.

Financial Assistance

A surprisingly large number of people qualify for financial help when buying health insurance through the Marketplace.
For example, someone who earns up to $47,080 a year, or a family of four earning up to $97,000 a year, qualifies for reduced monthly premiums or a tax credit at the end of the year.

By using one of several good calculators that are available, you can estimate how much assistance you may obtain—before you even visit the Marketplace site (www.HealthCare.gov). However, only the Marketplace will let you know the exact assistance you can expect.

Financial Assistance Calculator

Another calculator option, from the Kaiser Family Foundation, is found below:

Subsidy Calculator
Premium Assistance for Coverage in Exchanges

This tool estimates health insurance premiums and subsidies for people purchasing insurance in the Marketplace. It was developed by the Kaiser Family Foundation.

You can enter different incomes, ages and family sizes to estimate your eligibility for subsidies and how much you could spend on health insurance.

Financial Assistance Income Chart

Look for your income and household size on this chart to see whether you qualify for financial assistance when purchasing health insurance.

Household size

100%

133%

150%

200%

300%

400%

1

$11,770

$15,654

$17,655

$23,540

$35,310

$47,080

2

$15,930

$21,187

$23,895

$31,860

$47,790

$63,720

3

$20,090

$26,720

$30,135

$40,180

$60,270

$80,360

4

$24,250

$32,253

$36,375

$48,500

$72,750

$97,000

5

$28,410

$37,785

$42,615

$56,820

$85,230

$113,640

Why Choose Us?

When you compare plans, you’ll be able to see which hospitals are included in each one.

Be sure to choose a plan that includes St. Francis Medical Center so you’ll always have the latest treatment options, leading-edge technology and the region’s top-rated and most experienced physicians.

To learn more and find a solution right for you, call 609-456-0820 to speak to an enrollment representative.

Preventive Care Services

All marketplace plans must cover the following list of preventive services without charging you additional fees (copayment or coinsurance), even if you haven't paid your yearly deductible. However, you must receive these services from a healthcare provider in your network. Screenings are also available based on certain criteria and conditions.

All private health insurance plans on the Health Insurance Marketplace provide the same essential health benefits.
These are minimum requirements, but plans may offer additional coverage. Compare plans side-by-side on the Marketplace to see exactly what each offers.